Diabetic Foot & Chronic Wounds

Why wounds fail to heal

A wound that has not begun healing within two weeks has a reason. In the leg and foot, the usual culprits are:

• Poor arterial supply — narrowed leg arteries starve the wound of the blood it needs to heal
• Diabetes — nerve damage (neuropathy) means injuries go unnoticed, while small- and large-vessel disease slows healing and invites infection
• Venous hypertension — leaking vein valves cause the ulcers that form around the ankle
• Pressure — over bony points in patients with limited mobility

Dressings treat the surface. Unless the underlying cause is identified and corrected, the wound persists — which is why chronic wounds need vascular assessment alongside good wound care.

Diabetic foot: the stakes

For a person with diabetes, a foot ulcer is a limb-threatening event, not a skin complaint. Infection can spread quickly in a foot with poor sensation and poor blood flow, and delayed treatment is the common path to amputation. The reverse is also true: assessed early, many diabetic foot wounds can be healed and many amputations prevented — this is what limb salvage means in practice.

How I assess a chronic wound

• Clinical assessment of the wound, sensation and pulses
• Arterial and venous duplex ultrasound at the same visit — mapping blood supply and drainage
• Targeted imaging (CT or catheter angiography) where revascularisation is being planned
• Assessment of infection, including bone involvement where suspected

Treatment: restore flow, then heal the wound

• Revascularisation — reopening blocked leg arteries with angioplasty, atherectomy and stenting, or bypass surgery where endovascular options are unsuitable; adequate blood flow is the foundation the other measures depend on
• Debridement and wound bed preparation — removing dead tissue so healthy tissue can close
• Infection control — antibiotics, drainage and surgery as needed
• Offloading and footwear — removing the pressure that created the wound
• Compression therapy for venous ulcers once arterial supply is confirmed
• Ongoing surveillance — healed diabetic feet remain at-risk feet; regular review prevents recurrence

When to see a doctor promptly

Any foot wound in a person with diabetes; any wound anywhere that has not started healing in two weeks; spreading redness, warmth or odour; new foot pain at rest, or a foot that turns pale or cold. In a compromised foot, days change outcomes.